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A JOAOUIN Environmental Health Department —coura TEMPORARY FOOD VENDOR'S APPLICATION Adl food vendors r'both for profit and nary-protitl are required to return a sjgrp&d and completed ccpy of tt-tis cr)ecKlist to the feslival coordinator three 1.3,weeks proar to this evert_ 1_ ',.Name of Event (��d1•(iI Datei;s'•: 1_ The icilowing is triiormatoort about my organazatxi business: Name of orgarmatton.'business 91 b0ln&U� Andress. 387 J si Strut.S�t J r3r{:A 951 t 3 Phone: (ax ) 46634C6 Alternate_{ 3_ Last food to be sold or given ro the pubic- tacos. burrttrs.qun:ad ial. 113&ws.It ll-:,ague Pt sra 4_ 1 am prmod:ing food that is NOT prepared at home: El Yes❑ Nc Z.4d food is pmWred art-site cr is from approved commercal facilities.[D Yes ❑No Name of iaoiMy: 3 Harrnaros r,—mean Gnt Phone_( )4ss7,4r?6 .w3dress of iaCilAy S i^.3^ �.an J�isc CA 35113 5_ 1 am prov-adbng a booth with the lollowing:(to protect my uspackageci fccd and food-preparation areas from flies. dust and the pLibbc) [I A booth with watts and ceiling ccnstructed of e4ther wood, canvas_Mastic. smilar matena!and fine mesh fly scr`-erting, completely encaosing open food areas. tt will also have a smoot,i and cleanabe floor (cot-icrete. asphalt. clean tarps and snxxAh wood are acceptable)and constructed tc separate food and food pregaratian areas from the:-ublic. E]Other(specify). Fa0d ^-u_.. Nate: The only operations not required to provide enclosed booths are those which sell beverages from appro-.*d dispensers,or prepackaged food from approved sources. -d water for drinking. utensil and hand washrog will be provided in my booth by t1,e following methods. 1 .approved bottied water_ ❑On-sde base bib that is connected to a potable water source. ❑Other tspecifyl: 7. Electricity is provicled for my booth's use:[B Yes No 8_ 1 am providing art accurate probe thermometer to measure the not ana mad holding of potentially hazardous foods during all tines of booth operation:E]Yes❑No 9. 1 am providing the lallowing hot temperature control for the hot holding of all potentially hazardous foods above 135`F: [J Camp stove ❑Stemo&hotel trays ❑Double steamer ❑x Steam table& lids El Electric:stove t_,p E]Other Ispecity3 Note: Examples of potentially hazardous food include: meats, tamales. cooked beans. race, vegetables, potato salad,eggs,and dairy productts- 1.%8 E.Haaeltan Avenue Stockton_California 95205; T 209 4bb-3420 I F 2t39 464-0138 ( WW*.sjgov.org'ertd EHD 16-0 Pqp 7&11 TEMP EVENT APP Ois�4iYt23